Healthcare Provider Details

I. General information

NPI: 1346648771
Provider Name (Legal Business Name): DANIELLE THERSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S VINE ST
DENVER CO
80210-5264
US

IV. Provider business mailing address

5706 NW 149TH ST
VANCOUVER WA
98685-1272
US

V. Phone/Fax

Practice location:
  • Phone: 303-871-3626
  • Fax: 303-871-3625
Mailing address:
  • Phone: 720-675-9325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY60900766
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number3101
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPY60900766
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3101
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: